Employer-Employee Satisfaction

Employer-Employee Satisfaction

We want you and your employees to be satisfied with our service and care. If you have any questions or concerns about the care your employees receive, please contact us as soon as possible. It is especially important that you do this immediately if you believe their health may be affected. You may wish to complete the on-line Satisfaction Survey for Business & Industry to provide us with feedback on the services we provided.

Name: *

Employee's name: *

Title: *

Date of Injury: *

Company: *

Center visited: *

* Required fields

EMPLOYEE RATING
Please ask your employee to rate the urgent care center he or she visited on the basis of the following factors by using a “1” to “7” scale, where “7” is the best rating possible and “1” is the worst rating possible.

How would you rate: ( 7 = best, 1 = worst )

1. Conveniently located and easy to find

2. Ample convenient parking

3.	Building exterior, sidewalks & landscaping clean and orderly

4. Waiting room clean and comfortable

5. Entire clinic sanitary and well organized

6.	Courteous greeting immediately upon arrival

7.	Seen by medical staff in timely manner with minimal waiting

8. Courteous, professional staff

9. Overall quality of services and treatment

10.	Clear communication and instructions throughout visit

EMPLOYER RATING
Please rate Sisters of Mercy Urgent Care’s performance on the basis of the following factors by using a “1” to “7” scale, where “7” is the best rating possible and “1” is the worst rating possible.

How would you rate: ( 7 = best, 1 = worst )

11.	Clinician feedback on employee condition in timely manner

12. Accurate diagnosis

13.	Employee return to work within reasonable time frame

14. Open, timely communication

15. Courteous, professional staff

16. Reasonable fees

17. Accurate, understandable bills

EMPLOYER COMMENTS
We want to serve you better. Please provide your comments on how we can do so in the space below:

Thank you for your assistance on this survey.

Please let us know how we’re doing.
Just fill out the survey and hit the send button.

The security and confidentiality of your employees' health information are important to us. Our e-mail is not encrypted and, thus, could be viewed by other parties during transmission. Therefore we ask that you do not send personally identifiable health information to us via e-mail.

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		We comply with the HONcode standard for trustworthy health information: verify here.			Proud to be the first urgent care facilities in North Carolina to be certified by the UCAOA. For more info, click here.